Kiss Your Hemorrhoids Goodbye: Surgical and Non-Surgical Management Options
Patricia L. Raymond MD FACG, Rx For Sanity
There seem to be many options to manage our patients' hemorrhoids: hemorrhoidectomy, banding, sclerotherapy, laser photocoagulation, topical medications. Which option is the best for your patient? The physiology and management of the bitter end of the gastrointestinal tract.
Objectives: The participant will…
Distinguish between internal and external hemorrhoids, review the anorectal anatomy and understand the grading system for internal hemorrhoids.
Categorize the differential diagnosis of hemorrhoids, including proctalgia fugax, anal fissure, perianal crohns disease, anal cancer, condyloma, skin tags and rectal prolapse
Examine specific medical, endoscopic, office, and surgical treatment options for hemorrhoids and their stated efficacy
This document discusses hemorrhoidal disease, including definitions, incidence, pathogenesis, classification, symptoms, and treatment options. It defines hemorrhoids as dilated vascular channels located in three constant locations in the anus. Hemorrhoidal disease is manifested by prolapse, bleeding, and itching. Treatment options discussed include sclerosing injections, infrared photocoagulation, rubber band ligation, and hemorrhoidectomy. The preferences for treatment are outlined based on the degree of hemorrhoids.
This document provides an overview of abdominal wall hernias, including definitions, types, etiologies, anatomy, clinical features, and treatments. It describes the main types of groin hernias such as indirect, direct, and femoral hernias. It discusses the composition of hernias and provides classifications. For groin hernias specifically, it outlines the anatomy of the inguinal canal and contents, compares indirect and direct hernias, and describes surgical repair techniques like Bassini, Shouldice, and Lichtenstein. Femoral hernias are also summarized, including the anatomy of the femoral ring and canal.
This document provides information on differential diagnosis and evaluation of rectal bleeding. It discusses common causes such as hemorrhoids, anal fissures, and colorectal cancers. It describes approaches to history taking, physical examination, and investigations including proctoscopy, sigmoidoscopy, colonoscopy, and imaging. Key signs and symptoms of conditions causing rectal bleeding are summarized.
Hemorrhoids are enlarged or dilated veins in the lower rectum and anus. They commonly cause symptoms like painless rectal bleeding and protrusion from the anus. Risk factors include chronic straining during bowel movements, prolonged sitting, obesity, and pregnancy. Treatment ranges from lifestyle and dietary modifications to minimally invasive procedures or surgery. Surgical hemorrhoidectomy is reserved for grades III-IV hemorrhoids.
Please find the power point on Hemorrhoids. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
This document discusses hemorrhoidal disease, including definitions, incidence, pathogenesis, classification, symptoms, and treatment options. It defines hemorrhoids as dilated vascular channels located in three constant locations in the anus. Hemorrhoidal disease is manifested by prolapse, bleeding, and itching. Treatment options discussed include sclerosing injections, infrared photocoagulation, rubber band ligation, and hemorrhoidectomy. The preferences for treatment are outlined based on the degree of hemorrhoids.
This document provides an overview of abdominal wall hernias, including definitions, types, etiologies, anatomy, clinical features, and treatments. It describes the main types of groin hernias such as indirect, direct, and femoral hernias. It discusses the composition of hernias and provides classifications. For groin hernias specifically, it outlines the anatomy of the inguinal canal and contents, compares indirect and direct hernias, and describes surgical repair techniques like Bassini, Shouldice, and Lichtenstein. Femoral hernias are also summarized, including the anatomy of the femoral ring and canal.
This document provides information on differential diagnosis and evaluation of rectal bleeding. It discusses common causes such as hemorrhoids, anal fissures, and colorectal cancers. It describes approaches to history taking, physical examination, and investigations including proctoscopy, sigmoidoscopy, colonoscopy, and imaging. Key signs and symptoms of conditions causing rectal bleeding are summarized.
Hemorrhoids are enlarged or dilated veins in the lower rectum and anus. They commonly cause symptoms like painless rectal bleeding and protrusion from the anus. Risk factors include chronic straining during bowel movements, prolonged sitting, obesity, and pregnancy. Treatment ranges from lifestyle and dietary modifications to minimally invasive procedures or surgery. Surgical hemorrhoidectomy is reserved for grades III-IV hemorrhoids.
Please find the power point on Hemorrhoids. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
1) The document provides information on the evaluation and management of bleeding per rectum (BPR). It discusses the history, physical exam, differential diagnoses, investigations and treatment options for common causes of BPR.
2) Common causes of BPR include hemorrhoids, anal fissures, colorectal polyps, inflammatory bowel disease, diverticular disease, and colorectal cancers. The history can help determine if the bleeding is from distal or proximal lesions.
3) Physical exam involves digital rectal exam to feel for masses or other abnormalities. Initial investigations include labs, endoscopy, and imaging. Treatment depends on the underlying cause but may include medications, procedures like banding or surgery.
This document provides information on haemorrhoids (also known as hemorrhoids), including:
- Anatomy of the anal canal and haemorrhoidal tissue
- Epidemiology of symptomatic haemorrhoids, affecting around 4.4% of the global population
- Common causes like straining, pregnancy, obesity, and familial tendency
- Grading of internal haemorrhoids from first to fourth degree based on degree of prolapse
- Treatment options like rubber band ligation, sclerotherapy, excisional or stapled haemorrhoidectomy depending on severity
Chronic peripheral arterial occlusive disease is caused by atherosclerosis or thromboangiitis obliterans, narrowing blood vessels and reducing blood flow to limbs. Risk factors include smoking, hyperlipidemia, diabetes, and hypertension. Patients experience pain, ulcers or gangrene. Diagnosis involves ABI, angiography and Doppler ultrasound. Treatment includes lifestyle changes, medications, angioplasty, bypass surgery or amputation in severe cases. The goal is to improve blood flow, relieve symptoms and prevent limb loss.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
Diverticular disease is a common condition where pouches called diverticula bulge out from the colon wall, usually where blood vessels penetrate the colon. Diverticulosis is the presence of diverticula without inflammation, while diverticulitis occurs when diverticula become inflamed or infected, usually due to hard stool getting stuck in a diverticulum. Diverticulitis ranges from uncomplicated cases treated with antibiotics to complicated cases involving abscesses, fistulas, or perforation requiring surgery. Risk factors include low-fiber diet, aging, and high blood pressure.
This document discusses obstructive jaundice, including its definition, classification, pathophysiology, signs and symptoms, investigations, and treatment. It covers four main types of obstructive jaundice - complete obstruction, intermittent obstruction, chronic incomplete obstruction, and segmental obstruction. Causes discussed include CBD stones, tumors, strictures, cysts, and parasites. The role of radiology, biomarkers, and surgery in evaluating and managing obstructive jaundice is also summarized.
This document discusses different types of ventral hernias, including umbilical, epigastric, incisional, and paraumbilical hernias. It describes the causes, clinical features, diagnosis, and treatment options for each type. For treatment, it compares open surgical repair techniques like primary closure or mesh placement versus laparoscopic approaches. Complications of surgery like seroma, infection, and injury are also reviewed.
This document discusses various procedures for treating hemorrhoids, including Barron's banding, open and closed hemorrhoidectomy, stapled hemorrhoidectomy, and transanal hemorrhoidal dearterialization (THD). Barron's banding is used for first and second degree hemorrhoids as an office procedure under local anesthesia. Open hemorrhoidectomy involves making a V-cut to dissect and remove third degree hemorrhoids, while closed hemorrhoidectomy uses an elliptical incision and ligation. Stapled hemorrhoidectomy uses a circular stapler to remove hemorrhoidal tissue. THD involves identifying and ligating the hemorrhoidal arteries through the anus to reduce blood
this presentation includes anatomy physiology function of peritoneum ,also includes cause of peritonitis its severity ,various scoring system investigation and treatment.It includes the recent advancement and latest articles from latest books of surgery.
This document discusses special situations that may occur during laparoscopic appendectomy surgery. It notes that port positions may need to be modified for pregnancy and the appendix may need to be dissected along Toldt's white line if it is retrocaecal and extraperitoneal. For appendicular abscess, drainage and toiletting are needed to identify and remove the ruptured appendix, converting to open surgery if necessary. For an appendicular mass, conservative treatment is followed by interval appendectomy after one and a half months.
An abdominal mass can have various causes and require different treatments depending on the underlying condition. Examination of the patient and medical tests are needed to identify the location and cause of the mass. Common symptoms include abdominal pain, changes in appetite or bowel habits, weight changes, and the appearance of a mass. Serious symptoms may indicate life-threatening conditions like rapid mass growth or expansion accompanied by severe pain. Treatment options range from observation to surgery and may involve medications, drainage/removal of the mass, removal of part of an organ, or removal of the entire organ along with chemotherapy or radiation.
HEMORRHOIDS- Lower GI Hemorrhage
Dear Viewers,
Greetings from “Surgical Educator”
In this episode, I am talking about one of the common problems in Genaral Surgery- Hemorrhoids. I have talked on the Etiopathogenesis, Classification, Clinical Features, Investigations, Complications and Treatment. I have also included a Mindmap, a diagnostic algorithm and a treatment algorithm. I hope you will find it very useful and interesting. You can watch this video in the following links:
youtube.com/c/surgicaleducator
surgicaleducator.blogspot.com
Thank you for watching the video.
This document discusses anorectal abscesses and fistula in ano. It begins by defining anorectal abscesses as infections of soft tissues around the anal canal that form abscess cavities, often coinciding with fistula in ano. The peak incidence is in the third and fourth decades of life, affecting males more often. Causes include infection of anal glands, injury, Crohn's disease, and tuberculosis. Pathophysiology involves infection of anal glands leading to abscess formation in intersphincteric spaces. Abscesses are classified based on their location such as perianal, ischiorectal, or pelvirectal. Treatment involves incision and drainage. Fistula in ano results from
The document defines key terms related to intra-abdominal pressure (IAP) including intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). It discusses the physiologic consequences of increased IAP on multiple organ systems. Diagnosis of ACS requires IAP measurement, typically via intravesicular bladder pressure. Management focuses on supportive care to reduce IAP as well as surgical decompression for severe or refractory cases. Complications of an open abdomen include fluid/protein loss and fistula formation.
Hemorrhoids: A Common Condition And Effective Treatment OptionsSummit Health
This presentation about hemorrhoids includes discussion about causes and preventive measures as well as effective nonsurgical and surgical treatment options.
This document discusses the various causes of rectal bleeding, focusing on hemorrhoids. It defines internal and external hemorrhoids, explaining their locations and causes. Symptoms of internal hemorrhoids include painless bleeding during defecation and possible prolapse. Complications can include strangulation, thrombosis, and gangrene. Treatment options are discussed, including non-operative approaches like injection sclerotherapy, banding, and infrared coagulation, as well as operative techniques like open or closed hemorrhoidectomy and stapled hemorrhoidopexy. External hemorrhoids and related conditions are also briefly mentioned.
This document discusses the management of abdominal trauma. It begins with classifications for abdominal injuries and describes the pathophysiology of blunt and penetrating trauma. The primary and secondary surveys are outlined, including important physical exam findings. Diagnostic imaging options are presented, such as FAST ultrasound, CT scans, and DPL. Specific injuries to organs like the spleen are discussed. Management approaches for both blunt and penetrating trauma are covered, including options for non-operative management versus laparotomy. Damage control resuscitation principles and abdominal compartment syndrome are also mentioned.
There are many natural remedies for Hemorrhoids that helps in reducing the symptoms and signs of the Hemorrhoids quickly and easily.know more by visiting www.plus100years.com
1) The document provides information on the evaluation and management of bleeding per rectum (BPR). It discusses the history, physical exam, differential diagnoses, investigations and treatment options for common causes of BPR.
2) Common causes of BPR include hemorrhoids, anal fissures, colorectal polyps, inflammatory bowel disease, diverticular disease, and colorectal cancers. The history can help determine if the bleeding is from distal or proximal lesions.
3) Physical exam involves digital rectal exam to feel for masses or other abnormalities. Initial investigations include labs, endoscopy, and imaging. Treatment depends on the underlying cause but may include medications, procedures like banding or surgery.
This document provides information on haemorrhoids (also known as hemorrhoids), including:
- Anatomy of the anal canal and haemorrhoidal tissue
- Epidemiology of symptomatic haemorrhoids, affecting around 4.4% of the global population
- Common causes like straining, pregnancy, obesity, and familial tendency
- Grading of internal haemorrhoids from first to fourth degree based on degree of prolapse
- Treatment options like rubber band ligation, sclerotherapy, excisional or stapled haemorrhoidectomy depending on severity
Chronic peripheral arterial occlusive disease is caused by atherosclerosis or thromboangiitis obliterans, narrowing blood vessels and reducing blood flow to limbs. Risk factors include smoking, hyperlipidemia, diabetes, and hypertension. Patients experience pain, ulcers or gangrene. Diagnosis involves ABI, angiography and Doppler ultrasound. Treatment includes lifestyle changes, medications, angioplasty, bypass surgery or amputation in severe cases. The goal is to improve blood flow, relieve symptoms and prevent limb loss.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
Diverticular disease is a common condition where pouches called diverticula bulge out from the colon wall, usually where blood vessels penetrate the colon. Diverticulosis is the presence of diverticula without inflammation, while diverticulitis occurs when diverticula become inflamed or infected, usually due to hard stool getting stuck in a diverticulum. Diverticulitis ranges from uncomplicated cases treated with antibiotics to complicated cases involving abscesses, fistulas, or perforation requiring surgery. Risk factors include low-fiber diet, aging, and high blood pressure.
This document discusses obstructive jaundice, including its definition, classification, pathophysiology, signs and symptoms, investigations, and treatment. It covers four main types of obstructive jaundice - complete obstruction, intermittent obstruction, chronic incomplete obstruction, and segmental obstruction. Causes discussed include CBD stones, tumors, strictures, cysts, and parasites. The role of radiology, biomarkers, and surgery in evaluating and managing obstructive jaundice is also summarized.
This document discusses different types of ventral hernias, including umbilical, epigastric, incisional, and paraumbilical hernias. It describes the causes, clinical features, diagnosis, and treatment options for each type. For treatment, it compares open surgical repair techniques like primary closure or mesh placement versus laparoscopic approaches. Complications of surgery like seroma, infection, and injury are also reviewed.
This document discusses various procedures for treating hemorrhoids, including Barron's banding, open and closed hemorrhoidectomy, stapled hemorrhoidectomy, and transanal hemorrhoidal dearterialization (THD). Barron's banding is used for first and second degree hemorrhoids as an office procedure under local anesthesia. Open hemorrhoidectomy involves making a V-cut to dissect and remove third degree hemorrhoids, while closed hemorrhoidectomy uses an elliptical incision and ligation. Stapled hemorrhoidectomy uses a circular stapler to remove hemorrhoidal tissue. THD involves identifying and ligating the hemorrhoidal arteries through the anus to reduce blood
this presentation includes anatomy physiology function of peritoneum ,also includes cause of peritonitis its severity ,various scoring system investigation and treatment.It includes the recent advancement and latest articles from latest books of surgery.
This document discusses special situations that may occur during laparoscopic appendectomy surgery. It notes that port positions may need to be modified for pregnancy and the appendix may need to be dissected along Toldt's white line if it is retrocaecal and extraperitoneal. For appendicular abscess, drainage and toiletting are needed to identify and remove the ruptured appendix, converting to open surgery if necessary. For an appendicular mass, conservative treatment is followed by interval appendectomy after one and a half months.
An abdominal mass can have various causes and require different treatments depending on the underlying condition. Examination of the patient and medical tests are needed to identify the location and cause of the mass. Common symptoms include abdominal pain, changes in appetite or bowel habits, weight changes, and the appearance of a mass. Serious symptoms may indicate life-threatening conditions like rapid mass growth or expansion accompanied by severe pain. Treatment options range from observation to surgery and may involve medications, drainage/removal of the mass, removal of part of an organ, or removal of the entire organ along with chemotherapy or radiation.
HEMORRHOIDS- Lower GI Hemorrhage
Dear Viewers,
Greetings from “Surgical Educator”
In this episode, I am talking about one of the common problems in Genaral Surgery- Hemorrhoids. I have talked on the Etiopathogenesis, Classification, Clinical Features, Investigations, Complications and Treatment. I have also included a Mindmap, a diagnostic algorithm and a treatment algorithm. I hope you will find it very useful and interesting. You can watch this video in the following links:
youtube.com/c/surgicaleducator
surgicaleducator.blogspot.com
Thank you for watching the video.
This document discusses anorectal abscesses and fistula in ano. It begins by defining anorectal abscesses as infections of soft tissues around the anal canal that form abscess cavities, often coinciding with fistula in ano. The peak incidence is in the third and fourth decades of life, affecting males more often. Causes include infection of anal glands, injury, Crohn's disease, and tuberculosis. Pathophysiology involves infection of anal glands leading to abscess formation in intersphincteric spaces. Abscesses are classified based on their location such as perianal, ischiorectal, or pelvirectal. Treatment involves incision and drainage. Fistula in ano results from
The document defines key terms related to intra-abdominal pressure (IAP) including intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). It discusses the physiologic consequences of increased IAP on multiple organ systems. Diagnosis of ACS requires IAP measurement, typically via intravesicular bladder pressure. Management focuses on supportive care to reduce IAP as well as surgical decompression for severe or refractory cases. Complications of an open abdomen include fluid/protein loss and fistula formation.
Hemorrhoids: A Common Condition And Effective Treatment OptionsSummit Health
This presentation about hemorrhoids includes discussion about causes and preventive measures as well as effective nonsurgical and surgical treatment options.
This document discusses the various causes of rectal bleeding, focusing on hemorrhoids. It defines internal and external hemorrhoids, explaining their locations and causes. Symptoms of internal hemorrhoids include painless bleeding during defecation and possible prolapse. Complications can include strangulation, thrombosis, and gangrene. Treatment options are discussed, including non-operative approaches like injection sclerotherapy, banding, and infrared coagulation, as well as operative techniques like open or closed hemorrhoidectomy and stapled hemorrhoidopexy. External hemorrhoids and related conditions are also briefly mentioned.
This document discusses the management of abdominal trauma. It begins with classifications for abdominal injuries and describes the pathophysiology of blunt and penetrating trauma. The primary and secondary surveys are outlined, including important physical exam findings. Diagnostic imaging options are presented, such as FAST ultrasound, CT scans, and DPL. Specific injuries to organs like the spleen are discussed. Management approaches for both blunt and penetrating trauma are covered, including options for non-operative management versus laparotomy. Damage control resuscitation principles and abdominal compartment syndrome are also mentioned.
There are many natural remedies for Hemorrhoids that helps in reducing the symptoms and signs of the Hemorrhoids quickly and easily.know more by visiting www.plus100years.com
Anal fissure & fistula in ano PPT By Dr Anil Kumar, Assistant Professor, AIIM...Anil Kumar
This document provides information on the anatomy, physiology, examination, and common conditions of the anal canal. It begins with an overview of the gross anatomy of the anal canal, including the three zones, anal sphincter muscles, blood supply and development. Common conditions like anal fissure and fistula-in-ano are then discussed in detail, outlining their causes, types, clinical features and management options. Both conservative and surgical treatment approaches are covered for anal fissure and various surgical procedures for fistula-in-ano such as fistulotomy and seton placement.
The document outlines a business plan for a custom dress design business called Renee Rose that aims to provide custom dresses for women of all sizes and shapes. It discusses the target market, current competition, marketing strategy, goals for the first year including sales projections, and contingency plans. The business will focus on networking, social media marketing, and building a loyal customer base through quality custom designs.
Rose has many healing properties. Different parts of the rose plant can be used including rose water, petals, oil, and powder. Rose can help with issues like graying hair, reducing heat in the body, soothing eyes, and regulating menstruation. It also benefits teeth and gums, clears skin blemishes, and acts as a natural deodorant. Ancient doctors used rose to treat various ailments and it contains many vitamins and minerals that are beneficial to health.
Duneze better position_better_health_ (3)Rahul Rane
The document discusses the health benefits of squatting over sitting on the toilet and introduces Duneze, a product that allows users to squat while using a standard toilet. It notes the explosion of bowel issues in the last century coinciding with the popularization of sitting toilets. Duneze is presented as an add-on device that facilitates squatting, has safety and usability benefits, and received patents. Large potential markets are identified in Western countries where sitting toilets dominate. The document makes the case that Duneze can address this need and build a brand around health and lifestyle benefits.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Psyllium husk has several health benefits such as relieving diarrhea and acidity, cleansing the colon, promoting digestion, and controlling diabetes. It can cure both constipation and diarrhea. When taken with curd, it heals infections from diarrhea. Psyllium husks also create a protective wall in the stomach to reduce excess acid secretion. As it travels through the colon, it absorbs toxins and cleanses the colon, avoiding health issues.
Mangoes have many health benefits as well. Known as the "king of fruits", mangoes contain antioxidants that can fight cancers like colon, breast, and prostate. Mangoes also help lower cholesterol and control heart rate and blood pressure. Applying mango
Hello!
This is a quick review PPT for medical students.
It includes description at a glance of all the commonly occuring benign anal and perianal conditions like; haemorrhoids, fissure in ano, fistula in ano etc.
Hope this is worth sharing
haemorrhoids are the most common tyoe of gastroenterological disease. it is a nutritive disease. here is a quick review on hemorrhoids, its pathophysiology, clinical features, classification, diagnosis and management.
The hindgut develops from the caudal end of the embryonic gut tube. It gives rise to the distal two-thirds of the transverse colon, descending colon, sigmoid colon, rectum, and upper anal canal. The urorectal septum divides the hindgut into the anorectal canal and urogenital sinus. Failure of neural crest cell migration can result in Hirschsprung's disease where a portion of the colon lacks its nerve plexus and becomes dilated.
The document discusses the venous system and varicose veins. It describes the anatomy and function of veins, noting they return blood to the heart and help regulate body temperature. Varicose veins are dilated, tortuous veins above 4mm in diameter. Evaluation involves history, exam including tests like Trendelenburg-Brodie, and imaging like ultrasound Doppler. Treatment options include compression stockings, sclerotherapy, surgery such as vein stripping or ligation, and newer minimally invasive procedures. Complications can include thrombophlebitis, hemorrhage, skin changes if left untreated.
Haemorrhoids, anal fissures, and fistula-in-ano are common anorectal conditions. Haemorrhoids are abnormal veins in the anal canal that can cause bleeding. Anal fissures cause tearing of the anal lining and severe pain during bowel movements. Fistula-in-ano is an abnormal connection between the anal canal and skin that can cause discharge. Treatment depends on the type and severity but may include medications, procedures to cut or seal veins, or surgery.
This document discusses the arterial supply, venous drainage, and normal and abnormal ultrasound findings of the scrotum and testes. It describes the arterial supply from the testicular artery and other branches. The venous drainage is via the pampiniform plexus draining into the spermatic veins. Normal color Doppler shows low resistance flow in the testes. Common pathologies discussed include epididymitis, varicocele, testicular torsion, cysts and tumors. Features on ultrasound and Doppler help differentiate these conditions.
This document provides information on haemorrhoid management in primary care. It defines haemorrhoids as swollen blood vessels in the lower rectum. Risk factors include constipation, straining during defecation, heavy lifting, prolonged sitting, obesity, and pregnancy. Haemorrhoids are classified as external or internal, with internal haemorrhoids further classified by degree. Primary care management includes lifestyle and diet modifications, medical treatments like creams and suppositories, and screening and referral guidelines for conditions like colorectal cancer. Referral to surgery is recommended for complicated or advanced haemorrhoids.
1) The rectum is approximately 12 cm in length and extends from the rectosigmoid junction to the anal canal. It has multiple flexures and relations to surrounding structures.
2) Anal fistulas are abnormal communications between the anorectal canal and perianal skin. They are usually due to an infection and classified based on their relationship to the sphincter muscles.
3) Evaluation of anal fistulas involves history, examination with EUA, and sometimes imaging. Management depends on fistula type and involves techniques like fistulotomy, setons, advancement flaps, or newer procedures like LIFT to try and control the fistula while preserving sphincter function.
1) The rectum is approximately 12 cm in length and extends from the rectosigmoid junction to the anal canal. It has multiple flexures and relations to surrounding structures.
2) Anal fistulas are abnormal communications between the anorectal canal and perianal skin. They are usually due to infection and classified based on their relationship to the sphincter muscles.
3) Evaluation of anal fistulas involves history, examination with EUA, and sometimes imaging. Management depends on fistula type and may include fistulotomy, setons, advancement flaps, or newer techniques like LIFT.
Choanal atresia is a congenital condition where the posterior nasal openings are blocked or narrowed. It occurs due to a failure of rupture of the membrane separating the nasal cavity from the oral cavity during embryonic development. Clinically, it presents with nasal obstruction and discharge or cyclic cyanosis in infants. Diagnosis is confirmed with CT scan showing narrowing of the posterior nasal airway. Treatment involves surgical repair through a transnasal or transpalatal approach to reopen the nasal passage, with stenting sometimes needed. Recurrence of narrowing can occur.
Hemorrhoids are normal vascular structures in the anal canal that can become symptomatic due to straining, prolonged sitting, or pregnancy. Common symptoms include painless rectal bleeding, prolapse or bulging of tissue from the anus, itching, and pain from thrombosed external hemorrhoids. Hemorrhoids are classified based on location above or below the dentate line and degree of prolapse. Diagnosis is made through history of symptoms and physical exam finding hemorrhoidal tissue.
This document provides information about haemorrhoids (also known as piles), including:
1. Haemorrhoids are varicosities of the veins in the anal canal that are common, affecting around 25% of adults. Risk factors include constipation, pregnancy, liver disease, and heredity.
2. There are four grades of internal haemorrhoids based on the degree of prolapse. Symptoms include rectal bleeding, pain, itching, and swelling. Diagnosis involves examination and sometimes proctoscopy.
3. Treatment options range from conservative measures like diet changes to invasive procedures like rubber band ligation, injection sclerotherapy, and various surgical haemorrhoidectomy
This document discusses the anatomy, physiology, examination, and treatment of rectal prolapse. It describes the anatomy of the rectum including blood supply, drainage, and surrounding structures. Examination of the rectum and indications are outlined. Rectal prolapse is classified and risk factors, presentation, evaluation, and complications are covered. Both non-operative and surgical treatment options are summarized, including abdominal, laparoscopic, and perineal procedures.
1. Abdominal aortic aneurysm is a dilatation of the abdominal aorta to over 3cm in diameter, most commonly caused by atherosclerosis. It affects around 2% of the population and is more common in males and smokers.
2. Surgical or endovascular repair is recommended when the aneurysm reaches 5.5cm in men or 5cm in women to prevent rupture, which has a high risk of death. Endovascular repair involves placing a stent graft via catheterization to exclude the aneurysm from blood flow.
3. Postoperative monitoring involves imaging to check for endoleaks, where blood flows into the excluded aneurysm sac, which may require further intervention. Smoking cess
This document discusses various types of vascular injuries. It covers the basic principles of vascular injury including anatomy, type of injury, mechanisms, clinical manifestations, investigations and management. It describes different types of vascular injuries like laceration, transection, dissection, crush and thrombosis. It discusses evaluation and investigations like Doppler, duplex ultrasound, angiography, CT angiography and MRI. It covers management of vascular injuries in different body regions like neck, chest, abdomen and extremities. It provides guidelines on treatment approaches including operative versus endovascular management.
1. The rectum and anal canal have distinct anatomical features based on their embryological development and histology. The anal canal can be divided into upper and lower halves based on the dentate line.
2. Common anal conditions include hemorrhoids, anal fissures, abscesses, and fistulas. Hemorrhoids are swollen veins in the anal canal that can cause pain and bleeding. Anal fissures are tears in the lining of the anal canal that cause burning pain during bowel movements.
3. Examination of the anus involves inspection, digital examination, and proctoscopy. Potential malignancies include squamous cell carcinoma and adenocarcinoma, which are treated surgically with possible
The hindgut develops from the caudal end of the embryonic gut tube. It gives rise to the distal two-thirds of the transverse colon, descending colon, sigmoid colon, rectum, and upper anal canal. The urorectal septum divides the hindgut into the anorectal canal and urogenital sinus. Failure of neural crest cell migration can result in Hirschsprung's disease where a portion of the colon lacks enteric ganglia and becomes constricted.
The hindgut develops from the caudal end of the embryonic gut tube. It gives rise to the distal two-thirds of the transverse colon, descending colon, sigmoid colon, rectum, and upper anal canal. The urorectal septum divides the hindgut into the anorectal canal and urogenital sinus. Failure of neural crest cell migration can lead to Hirschsprung's disease, where a portion of the colon lacks enteric ganglia and becomes constricted.
This document provides an overview of common anorectal diseases including hemorrhoids, anal fissure, and anorectal abscesses. It discusses the anatomy, risk factors, types, clinical features, and treatment options for each condition. Key points include that hemorrhoids are normal cushions in the anal canal that only require treatment if symptomatic, anal fissures are tears in the anoderm that cause pain with bowel movements, and anorectal abscesses form from infected anal glands that can spread along different anatomic planes requiring surgical drainage.
Detailed presentation on Varicose veins, examination and management
Detailed presentation on Deep Vein Thrombosis, categories, staging and scoring systems and management.
Management also includes Endovascular and Surgical techniques.
Short notes made on IVC filters
Similar to Kiss Your Hemorrhoids Goodbye: Surgical and Non-Surgical Management Options (20)
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Diverticulitis: Popular Misconceptions & New Management rev 2019Patricia Raymond
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Identify the role of the Registered Dietitian and the importance of a multi-disciplinary approach to the management of digestives diseases
Know GI Inside & Out? Recognizing Skin Lesions of GI DisordersPatricia Raymond
Skin lesions seen with disorders of the digestive tract are not rare; would you recognize and correctly correlate erythema nodosum, dermatitis herpetiformis, pyoderma gangrenosum? Those were easy-- how about pyoderma vegetans, pyostomatitis vegetans, sweet’s syndrome, xanthomas, tripe palms, palmoplantar keratoderma, or trichilemmomas? Stumped?
Join us and learn the art of GI diagnosis without resorting to our endoscopes.
Fun Functional Gallbladder Disorders: Update on Hypo and Hyperkinetic Gallbla...Patricia Raymond
Functional gallbladder disorder is biliary pain from motility disturbance in the absence of gallstones, sludge, or microcrystal disease. In patients with biliary-type pain and a normal US, the prevalence is 8% men and 21% women. We will review the clinical manifestations, diagnosis, and management of patients with suspected functional gallbladder disorder, and also address current evaluation and management of sphincter of Oddi dysfunction.
Cyst Assist: Pancreatic Cyst Evaluation & ManagementPatricia Raymond
This document provides an overview of pancreatic cyst evaluation and management. It discusses the prevalence of incidentally detected pancreatic cysts on imaging and categorizes cysts as benign, pseudocysts, or one of four subtypes of pancreatic cystic neoplasms (PCNs): serous cystic tumors, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, and solid pseudopapillary neoplasms. For each PCN subtype, it describes characteristics such as patient demographics, location, risk of malignancy, and management guidelines. It also reviews guidelines for managing pseudocysts and outlines the endoscopic, percutaneous, and surgical drainage options with expected outcomes. In summary,
Kudos To You: Learning your Kudo Pit Patterns and Paris Polyp ClassificationsPatricia Raymond
We've told patients that we won't know about their polyps until after the pathology report is back; turns out that's not precisely true. Today's excellence in optics provides an accurate instantaneous assessment of the histology of colon polyps which may help in decision making during colonoscopy.
Did you know that if a polyp has a type 5 Kudo pit pattern, 50% were invasive cancers to the submucosal layer? What is it about that scary polyp that raises your hackles? Join us in this highly interactive session where we'll learn Kudo pit patterns as well as Paris polyp classifications to elevate your GI procedure reporting and your patient care.
Describe the emerging evidence supporting the primary role of Kudo Pit Patterns in visual inspection of in situ polyps, and demonstrate your ability to identify the patterns
Authentication of Kudo Pits
Pits and their risks
Images of Kudo pits
Quiz of Kudo Pits
Discuss the potential and shortcomings of the Paris Polyp Classification, and demonstrate an ability to classify the polyp shape
Polyp shapes and and their risks (pedunculated, elevated, depressed)
Images of polyps for Paris classification
Polyps and their risks
Quiz of polyp shapes
Concerns regarding interobserver variability
Familial Adenomatous Polyposis affects 1 in 10,000 to 30,000 Americans who experience 100% risk of colon cancer, and FAP doesn't end with a total colectomy for removal of their hundreds of polyps.
Follow this journey of two real FAP patients through pancreatitis from symptomatic ampulla polyps, surgical resection of giant small bowel polyps, bowel obstruction from abdominal desmoid tumors, and Wilm's tumor of the kidney. How do we diagnose, monitor and support our FAP patients? Can pharmacotherapy reduce risk of polyp growth in FAP? What are the extracolonic manifestations of the APC gene mutation? Our responsibility doesn't end when the colon does.
Bored with Barretts: Diagnosing Gastric Intestinal Metaplasia, Meckels, & Pa...Patricia Raymond
We all know what to do with the border disorder that is Barretts, but what about other mucosal heterotopia: intestinal mucosa in the stomach, stomach mucosa in the intestine, pancreas mucosa in the stomach...what's going on with all this meandering mucosa? Join us for a discussion about how to diagnose and manage various misplaced gastrointestinal mucosa.
Discuss the natural history of Gastric Intestinal Metaplasia and construct proper endoscopic surveillance and mapping guidelines
Epidemiology and risk factors
Complete and incomplete, types I-III based on mucin expression
Risk of progression to cancer
Proper surveillance and endoscopic mapping
Management
35 min
Meckels
Describe the presumed anatomical development of Meckel's Diverticulum, summarize the 'Rule Of Twos', formulate management of a Meckel's associated cryptic bleed
Who was Meckel
Epidemiology and risk factors
Rule of twos
Risk of bleed
Management
10 min
Pancreatic Rests
Discuss the natural history of Gastric Intestinal Metaplasia and construct proper endoscopic surveillance and mapping guidelines
Review the endoscopic appearance of the Pancreatic Rest, discuss rare symptoms attributable to the finding and current endoscopic evaluation and management
Endoscopic appearance
Anatomic development
Risks for pancreatitis, cancer, obstruction
Endoscopic and surgical management
10 min
The document discusses the visual examination of the belly and navel from anatomical, historical, social, and medical perspectives. Anatomically, the navel is located at the midpoint of the body and develops from the umbilical cord that nourishes the fetus. Historically, many religions and cultures have ascribed spiritual or theological significance to the navel. Medically, examination of the navel can provide clues to intra-abdominal diseases and conditions. Variations in navel appearance like outies can occur normally or indicate issues like hernias.
Do You Believe in Reflux: Idiopathic Pulmonary FibrosisPatricia Raymond
Recent studies suggest that if you have IPF (idiopathic pulmonary fibrosis), that you may not perceive the GERD (reflux) that you have, and that this acid reflux may cause the fibrosis to progress. Ask for proper testing and treatment to see if you are one of the almost 80% of IPF patients who have reflux, often silent reflux.
This document summarizes key points from a presentation on restoring hospitality to hospital care. It emphasizes treating the whole person, not just the disease, and using a patient-centered approach. This involves greeting patients with courtesy, making them feel comfortable, clearly explaining their treatment plan, and finding ways to bring joy to difficult situations. The goal is to win by treating the person, not just curing the disease.
Hospitals have become unfriendly places for patients to be in…rushed, harried staff simply doesn’t have the time to provide the personal touch anymore…or can we? Delighted patients refer their friends and return for repeat procedures.
The ‘Spa Hospital’ addresses our patients’ needs with low or no cost techniques adapted from those used at spas. Attention will also be given to reception and departure from unit, patient privacy concerns, and their lasting impression with reviews of medical literature supporting these techniques.
Diverticulitis: Popular Misconceptions and New ManagementPatricia Raymond
Of course, it's not about just avoiding nuts and seeds. However, do you know how many attacks you can endure before suggesting a resection? How to manage young or immunosuppressed patients with diverticulitis? How Eastern (asian)diverticulitis differs? The role of mesalamine in treatment? It's time to re-explore a disease that you thought you knew!
This document contains information from a gastroenterologist on various gastrointestinal conditions including secretory diarrhea, Giardia infection, celiac disease, lactose intolerance, protein-losing enteropathy, small bowel bacterial overgrowth, irritable bowel syndrome, mesenteric ischemia, and Whipple's disease. It includes diagnostic criteria, clinical features, diagnostic tests, treatment recommendations, and prevalence statistics for each condition.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
3. • Medieval physicians used
cautery irons to treat
hemorrhoids
• Others believed that
simply pulling them out
with their fingernails was
the cure (a solution
endorsed by the Greek
physician, Hippocrates)
4. Hemorrhoids are caused by:
• Straining
> Work strain (lifting
patients, etc.)
> Straining while
defecating
— Chronic constipation
— Passing hard, dry,
small stools
— Laxative abuse
• Increased intra-
abdominal pressure
> Pregnancy
• Being alive
5. • 10 million people in the United States have
hemorrhoids
> Prevalence rate 4.4%.
> Peaks from age 45-65 years
> Decrease after age 65 years
> Hemorrhoids before age 20 unusual.
• Caucasian > African American
• Increased prevalence rates associated with
higher socioeconomic status
The prevalence of hemorrhoids and chronic constipation. An epidemiologic
study. Johanson JF, Sonnenberg A Gastroenterology. 1990;98(2):380.
6. • Contrast hemorrhoids with the epidemiology
of constipation
> Exponential increase after age 65 years
> More common in blacks
> More common in families with
low incomes or low social status
—Causality between constipation and
hemorrhoids questioned
The prevalence of hemorrhoids and chronic constipation. An epidemiologic
study. Johanson JF, Sonnenberg A Gastroenterology. 1990;98(2):380.
8. • Arise from a plexus
(sometimes called a
"cushion") of dilated
arteriovenous
channels and
connective tissue
• Veins from the
superior, middle, and
inferior rectal vein
http://web.uni-
plovdiv.bg/stu1104541018/docs/res/skandalakis%27%20surgical%20anatomy%2
0-
%202004/Chapter%2018_%20Large%20Intestine%20and%20Anorectum_fichier
s/loadBinaryCABXCEBK.jpg
9. The Dentate Line
• External or internal based
upon whether they are
below or above the
dentate line
> The dentate line) is a line
which divides the upper
2/3 and lower 1/3 of the
anal canal.
Developmentally, this line
represents the hindgut-
proctodeum junction
• Often both types of
http://shoppe.listentoyourgut.com/hemorrheal-external-
hemorrhoids coexist
hemorrhoid-kit-ebook-ingredients/
10. Internal hemorrhoids
• Arise from the superior
hemorrhoidal cushion.
• Three primary locations
> left lateral, right anterior, and
right posterior
• Fed from the end
branches of the middle
and superior rectal veins
• Overlying mucosa is rectal
• Innervation is visceral
http://tophemorrhoidtreatments.com/internal-and-
external-hemorrhoids
11. External hemorrhoids
• Arise from the inferior
hemorrhoidal plexus
• Located beneath the
dentate line
• Covered with
squamous epithelium
> Numerous somatic pain
receptors.
http://proctologyspecialists.com/procedures/thr
ombosed-external-hemorrhoid
16. Rectal varices
• Hemorrhoids have direct
communication with the portal
system, and can also exist in
close proximity to rectal varices
in patients who have portal
hypertension
• Hemorrhoids are not more
common in patients with portal
hypertension
• Rectal varices are treated with
banding or TIPPS
http://integrisok.com/nazih-zuhdi-transplant-institute-
oklahoma-city-ok/pre-liver-transplant-work-up
http://www.gastrointestinalatlas.com/English/Colon_and_
Rectum/Miscellaneous/miscellaneous.html
38. Classification of internal hemorrhoids
• Degree of prolapse
from the anal canal:
> Grade I visualized on
anoscopy, and may
bulge into the
lumen, but do not
extend below the
dentate line
> Grade II prolapse out of
the anal canal with
defecation or with
straining, but reduce http://www.endoatlas.org/index.php?page=results_jquery&mstc
spontaneously at=5&subcat=8
39. Prolapsed Internal Hemorrhoids
> Grade III prolapse out
of the anal canal with
defecation or straining,
and require the patient
to reduce them into
their normal position
> Grade IV hemorrhoids
are irreducible and may
strangulate
http://www.uptodate.com/contents/image?imageKey=SURG%2
F64871&topicKey=SURG%2F15025&rank=1~34&source=see_
link&search=rectal+prolapse&utdPopup=true
40. No widely used classification system
of external hemorrhoids exists!
43. Hemorrhoid Advice by Anonymous
Even though it may take Though its been said, it
weeks bears repeating;
To heal the wound Nothing but canned soup
between your cheeks, for eating.
I provide this rule of Fruit will get your bowels
thumb a-grooving
To nurse your Before you know it, you’ll
recuperating bum. be up and moving
44. Exercise is out of the Heed my advice and
question! don’t be foolish,
Beware of any such The results may be so
suggestion. very ghoulish.
No unicycles, horseback To avoid a thrombosis so
riding. abrupt,
Leapfrog, bowling, or Keep your cool and
ninja fighting. Bottoms Up!
45.
46. Conservative Management of Hemorrhoids
• Bleeding
> Fiber
• Pruritis
> Topical Creams
> Hydrocortizone
> Sitz Baths
> (?Fiber)
• General
> Cleansing wipes
> NTG/Ca channel
blockers
47. Fiber and Hemorrhoids
• Meta-analysis of
seven controlled trials
> fiber supplementation
reduced bleeding (RR
0.50, 95% CI 0.28-0.68)
• Hemorrhoidal
prolapse was not
affected by fiber
supplementation
Laxatives for the treatment of hemorrhoids.
Alonso-Coello P, Guyatt G, Heels-Ansdell D,
Johanson JF, Lopez-Yarto M, Mills E, Zhou Q
Cochrane Database Syst Rev. 2005
48.
49. Irritation and pruritus
• Sitz baths • Analgesic creams,
> Warm water two to hydrocortisone
three times per day suppositories, & warm
— Effectiveness may in part sitz baths
be related to relaxation of
the internal anal sphincter • Do not use creams or
• Fiber supplementation hydrocortisone > one
may relieve pruritus week
related to fecal soilage > Side effects may occur
> bulking effect of fiber — Contact dermatitis with
analgesic creams
may reduce leakage of
— Mucosal atrophy with
liquid stool steroid creams
50. Avoid Spicy Foods? Capsaicin for hemorrhoids
• No evidence that spicy
foods worsen irritation
and pruritus
Red hot chili pepper and
hemorrhoids: the explosion of a
myth: results of a prospective,
randomized, placebo-controlled,
crossover trial.
Altomare DF, Rinaldi M, La Torre F,
Scardigno D, Roveran A, Canuti S,
Morea G, Spazzafumo L Dis Colon
Rectum. 2006;49(7):1018.
Gut. 2003 September; 52(9): 1323–
1326. Topical capsaicin—a novel
and effective treatment for
idiopathic intractable pruritus ani: a
randomised, placebo controlled,
crossover study J Lysy, M Sistiery-
Ittah, Y Israelit, et al.
51. Witch hazel (Hamamelis)
• Astringent
• Various forms
> Ointments, pads
> Little scientific
evidence, said to
temporarily shrink
hemorrhoids
„Napoleon's Haemorrhoids', by Phil Mason,
says that the French emperor was suffering from
an acute attack of piles that stopped him riding
his horse, and supervising the troops during the
battle of Waterloo.
Two days before the battle, Napoleon's doctors
lost the leeches that they used to relieve his
agony, and accidentally overdosed him with the
painkiller laudanum. Napoleon was still suffering
from the effects of the painkiller when the battle
broke out.
52.
53. Other Conservative Management Ideas
• Moistened hypoallergenic
wipes
• Nitoglycerine ointment
> Rectiv 0.4%
• Diltiazem/Nifedipine ointment or
combined
Dis Colon Rectum. 2001 Mar;44(3):405-9.
Conservative treatment of acute
thrombosed external hemorrhoids with
topical nifedipine. Perrotti P, Antropoli C,
Molino D, De Stefano G, Antropoli M.
J Coll Physicians Surg Pak. 2009
Oct;19(10):614-7
Topical diltiazem hydrochloride and
glyceryl trinitrate in the treatment of
chronic anal fissure Jawaid M, Masood Z,
Salim M
54.
55. Ambulatory Procedures for Internal Hemorrhoids
• Remove or to cause • Rubber band ligation
sloughing of excess • Infrared coagulation
hemorrhoidal tissue • Bipolar diathermy (Bicap)
• Healing and scarring • Laser photocoagulation
fixes the residual • Sclerotherapy
tissue to the • Cryosurgery
underlying anorectal
muscular ring
56. Which ambulatory technique for internal hemorrhoids?
Meta analysis of 18 trials
• Surgical hemorrhoidectomy • Rubber band ligation
better than dilation or band obliterated varices better than
ligation for preventing recurrent sclerotherapy.
symptoms. • Patients treated with
• Rubber band ligation was sclerotherapy or infrared
associated with fewer coagulation were more likely to
complications and pain than require further treatment than
surgery. those with rubber-band ligation.
Based upon these findings, it was suggested
that the optimal treatment for symptomatic
grade I to III hemorrhoids unresponsive to
conservative measures was rubber band
ligation. of hemorrhoidal treatments: a meta-analysis.
Comparison
MacRae HM, McLeod RS Can J Surg. 1997;40(1):14.
57.
58. Complications of rubber band ligation
• Pain 8% • Thrombosis
> Misapplication of the > distal hemorrhoids
band below the dentate thrombose, leading to
line or spasm pain or a palpable
• Delayed hemorrhage mass.
> When the rubber band • Infection/abscess
dislodges, typically 2-4 > Persistent pain, fever,
days post procedure or or foul smelling rectal
ulceration/ mucosal drainage Sepsis is rare
sloughing at 5-7 days
61. External hemorrhoids:
Thrombosis management—soon or not at all
• External • After 48 hours,
hemorrhoids do not organization of the
usually require thrombus and
minimally invasive improvement of
or surgical therapy symptoms no need
• Patients seen within for surgical
72 hours of evacuation
thrombosis may
benefit from surgical
evacuation for pain
relief
62.
63. But if you need to say “YES”…
• Initial treatment of choice in patients with
> symptomatic or strangulated grade IV hemorrhoids
> symptomatic grade III hemorrhoids
> thrombosed external hemorrhoids.
• American Gastroenterological Association, 2004
> Failure of medical and nonoperative therapy
> Symptomatic third-degree, fourth-degree, or mixed internal and external
hemorrhoids
> Symptomatic hemorrhoids in the presence of a concomitant anorectal
condition that requires surgery
> Patient preference after discussion of the treatment options with the
referring physician and surgeon.
64. Techniques for the operative treatment of hemorrhoids
• Closed
hemorrhoidectomy
• Open
hemorrhoidectomy
with excision and
ligation
• Stapled
hemorrhoidectomy
• Lateral internal
sphincterotomy
65. Closed hemorrhoidectomy
• The most common • Make the ellipse relatively
surgery for internal narrow, and to remove
hemorrhoids only the redundant
• Elliptical incision is made anoderm and
starting on the external hemorrhoidal tissue, close
hemorrhoidal tissue and defect with continuous
extending proximally absorbable suture
across the dentate line to • Three columns treated
the superior extent of the • 95% successful, low
hemorrhoidal column infection rate
69. Proctalgia fugax
• Intermittent, recurrent, • 4 to 18% of population,
severe, self-limited although only 17 to 20
functional rectal pain percent of patients report
> Pain for few seconds to two symptoms to MD
hours, asymptomatic • 58 to 84 female
between episodes, < 5 x per
year in 50% • Mean age at dx 46 - 58
years
• NOT more common in
patients with IBS
• Diagnosis requires
exclusion of other causes
of rectal or anal pain
70. Proctalgia fugax
• Pathophysiology • Treatment (?)
> Spasm of the smooth > Warm water 40 o C /104 o F
muscle of the internal as hot baths and warm water
enemas
anal sphincter (we
> Topical nitroglycerin
think!)
> Oral nifedipine or diltiazem
> Pudendal nerve > Inhaled albuterol
compression or > Also: Botulinum toxin
neuralgia injection, pudendal nerve
blocks, and superior
hypogastric plexus blocks
71. St. Fiacre
the patron saint of
hemorrhoid suffers
Also:
• gardeners
• taxi cab drivers
• venereal disease sufferers
• barrenness
• box makers
• fistula sufferers
• florists
• hosiers
• pewterers
• tile makers
• ploughboys
72. St. Fiacre
the patron saint of hemorrhoid suffers
• Seventh century Irish monk
• Developed hemorrhoids from
digging in his garden
• Sat on a stone which gave
him a miraculous cure.
• The stone survives to this
day with the imprint of his
hemorrhoids and is visited
by many hoping for a
similar cure.
• Inflamed hemorrhoids
often ―St. Fiacre‟s
curse‖ in the Middle
Ages.
76. “Hemorrhoids” parody by Butt Meddler
(loosely to “Yesterday”)
Before today,
My anal sphincter was a happy Why they had to come on my
place bum, I couldn’t say
It existed in a state of grace Preparation H and Sitz baths
I didn’t know there’d be hell to are just cliché!
pay.
Suddenly, there’s a thingie Hemorrhoids leave my rectum
hanging out of me feeling so annoyed
And the itch and pain won’t let Now some rubber bands have
me be been deployed
Oh hemorrhoids prolapse Now hemorrhoids are
suddenly. yesterday.